Pharmaceutical compositions comprising sorbitan esters

ABSTRACT

The present invention relates to a pharmaceutical composition comprising sorbitan esters of carboxylic acids that are useful for the delivery of anti-psychotic drugs.

RELATED APPLICATION

This application is a divisional of U.S. patent application Ser. No.13/423,606, filed Mar. 19, 2012, which claims priority to U.S.Provisional Application No. 61/454,008, titled “Formulations HavingImproved Site Reactions”, filed on Mar. 18, 2011. The contents of anypatents, patent applications, and references cited throughout thisspecification are hereby incorporated by reference in their entireties.

TECHNICAL FIELD

The present invention relates to an injectable, pharmaceuticalcomposition comprising sorbitan esters of carboxylic acids that areuseful for the delivery of anti-psychotic drugs.

BACKGROUND OF THE INVENTION

U.S. Pat. Nos. 4,734,416 and 5,006,528 discloses aripiprazole,7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxy}-3,4-dihydro-2(1H)-quinolinoneor 7-{4-[4-(2,3-dichlorophenyl)-1-piperazinyl]butoxy}-3,4-dihydrocarbostyril, as an atypical antipsychotic agent useful in the treatmentof schizophrenia, bipolar disease, depression and other CNS disorders.Aripiprazole has the following chemical structure:

Aripiprazole is sold under the tradename Ability®. It acts as a dopamineD₂ partial agonist, serotonin 5-HT_(1A) receptor agonist and is anantagonist of the serotonin 5-HT_(2A) receptor. Abilify® is currentlyadministered orally on a once-a-day dosing schedule as Abilify®(aripiprazole) Tablets, Ability Discmelt® (aripiprazole) OrallyDisintegrating Tablets and Abilify® (aripiprazole) Oral Solution. In oneembodiment, Abilify® Injection for intramuscular use is a rapid-actingsolution product for treating agitation associated with schizophreniaand bipolar disease. Poor and variable patient compliance with aonce-a-day dosing schedule of psychiatric drugs has been reported.

Efforts have been made to provide drug dosage forms that may increasethe compliance of patients and thereby lower the rate of relapse in thetreatment of schizophrenia. U.S. Pat. No. 7,807,680 and U.S. PublicationNo. 2005/0032811 describe long-acting aripiprazole sterile injectableformulations. Studies on aripiprazole free base injections showed aprolonged pharmacokinetic profile, but incidents of unacceptable(moderate to severe) tissue irritation following IM and SC injectionwere also reported.

U.S. Pat. No. 7,115,587 discloses an injectable formulation thatdelivers an aripiprazole solution complexed with a substitutedβ-cyclodextrin to the muscular site with diminished irritation ascompared to injectable suspensions containing uncomplexed aripiprazole.The Abilify® injection for intramuscular use is a single-dose, ready touse vial consisting of 9.75 mg/1.3 ml of aripiprazole and 150 mg/ml ofsulfobutylether β-cyclodextrin. Formulation challenges due to drugloading and poor solubility of aripiprazole in β-cyclodextrin at neutralpH have been reported.

Olanzapine(1,2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b][1,5]benzodiazepine)is a second generation antipsychotic drug marketed as Zyprexa®. It isuseful for the treatment of disorders such as schizophrenia, bipolardisorder, psychotic depression and Tourette syndrome. This activepharmaceutical ingredient acts as an antagonist on 5-HT₂ serotoninreceptors as well as the D₁/D₂ dopamine receptors, while also exhibitinganticholinergic and antimuscarinic properties. Olanzapine belongs to thebenzodiazepine family, and has the following structure:

This compound is disclosed, for example, in U.S. Pat. Nos. 5,229,382 and6,169,084. An extended release intramuscular injection productcontaining the water-insoluble salt olanzapine pamoate monohydrate isapproved for use in schizophrenia. Like aripiprazole, olanzapine cancause adverse site reactions when injected into a subject.

SUMMARY OF THE INVENTION

There exists a need for improved pharmaceutical compositions ofaripiprazole, olanzapine, prodrugs thereof, and other anti-psychoticagents, for extended release use, thereby improving patient complianceand optimizing the pharmacological profile of the active agent.

Provided herein are pharmaceutical compositions comprising (a) awater-insoluble antipsychotic agent, and (b) sorbitan esters of acarboxylic acid, wherein the carboxylic acid comprises 8-14 carbonatoms. In a particular embodiment, the sorbitan ester is sorbitanlaurate (SML). In an embodiment, the composition can be in the form ofan aqueous, flocculated, injectable suspension. The composition cancomprise additional components, such as a polyoxyethylene derivative ofa sorbitan ester of a carboxylic acid, wherein the carboxylic acidcomprises 8-14 carbon atoms (e.g., polysorbate 20). The pharmaceuticalcomposition can be injectable.

These pharmaceutical compositions can take a variety of forms. Suchforms include, but are not limited to, completely dispersed andflocculated systems.

As described below, the pharmaceutical compositions described hereinhave a number of advantages. For example, the compositions can be easilyresuspended by the user, e.g., through handshaking, in a short timeprior to administration. In another example, the pharmaceuticalcompositions, e.g., flocculated systems, can be used to improve thelocal tissue reaction of antipsychotic drugs in extended releaseformulations. By mitigating the adverse results associated with theinjection of these drugs, drug compliance will be greatly improved.

Water insoluble antipsychotic agents that can be used in thepharmaceutical compositions described herein include aripiprazole, aswell as prodrugs thereof, and olanzapine, as well as prodrugs thereof.Particular prodrugs of aripiprazole include compounds of the formula (I)or formula (II), e.g., compounds of the formula (I′), e.g., compoundsA-4 and A-7:

Particular prodrugs of olanzapine include compounds of the formula (III)or (IV):

In another aspect, provided herein is a pharmaceutical compositioncomprising:

(a) a water-insoluble antipsychotic agent;

(b) sorbitan esters of a carboxylic acid, wherein the carboxylic acidcomprises 8-14 carbon atoms;

(c) a polyoxyethylene derivative of a sorbitan ester of a carboxylicacid, wherein the carboxylic acid comprises 8-14 carbon atoms; and

(d) an aqueous vehicle;

wherein the composition forms an aqueous, flocculated, injectablesuspension.

The composition comprising components (a)-(d) can have components atvarying ratios. For example, in one embodiment of the compositioncomprising components (a)-(d), the composition comprises components (b)and (c) at a ratio that results in flocs comprising component (a),wherein the flocs settle to a predetermined sediment bed height, suchthat components (a), (b) and (c) can be resuspended for injection. In anembodiment, the bed height is comprised of at least a 20 to 80% increasein sediment height compared to a non-flocculated suspension after 24hours of undisturbed sitting, and, in another embodiment, components(a), (b) and (c) can be resuspended for injection within 1-60 seconds ofhandshaking. In another embodiment, the ratio of components (b) to (c)is such that the composition can be injected using a 20 to 25 gaugeneedle.

In a particular embodiment, the ratio of components (b) to (c) isapproximately 5 to 2, by weight.

When component (b) is sorbitan laurate, the composition can compriseabout 0.2-1 weight percent, about 0.4-0.7 weight percent or about 0.5weight percent sorbitan laurate.

When component (c) is polysorbate 20, the composition can comprise about0.05-0.8 weight percent polysorbate 20, about 0.1-0.3 weight percentpolysorbate 20, or about 0.2 weight percent polysorbate 20.

In an embodiment, the flocs of the pharmaceutical composition have thefollowing sizes: Dv[10]: 2-10 μm, Dv[50]: 10-30 μm, and Dv[90]: lessthan 80 μm (e.g., approximately 65 um). In another embodiment, the flocsare Dv[10]: 1-10 μm, Dv[50]: 5-30 μm, and Dv[90]: less than 65 μm.

The compositions can have varying amounts of antipsychotic agent in thepharmaceutical composition. For example, the composition can becomprised of 15-35 weight percent, e.g., 20-30 weight percent, e.g.,20-26 weight percent aripiprazole, or olanzapine, or a compound offormula I, II, III, IV or V (lurasidone).

In another aspect, provided herein is an aqueous injectable suspensioncomprising:

(a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IVor V, pharmaceutically acceptable salts, hydrates, or solvates thereof,

wherein component (a) is in a weight ratio of approximately 15-35%;

(b) sorbitan laurate in a weight ratio of approximately 0.2-1%

(c) polysorbate 20 in a weight ratio of approximately 0.05-0.8%; and

(d) an aqueous carrier.

In one embodiment of the aqueous injectable suspension, the componentsare as follows:

(a) aripiprazole, or olanzapine, or a compound of formula I, II, III, IVor V in a weight ratio of approximately 20-26%;

(b) sorbitan laurate in a weight ratio of approximately 0.5%;

(c) polysorbate 20 in a weight ratio of approximately 0.2%; and

(d) an aqueous carrier.

In one embodiment, the pharmaceutical composition is formulated for usein delivering a water-insoluble antipsychotic agent into a host. In apreferred embodiment, the host is human. The composition can be intendedfor parenteral (e.g., intramuscular, intradermal or subcutaneous)administration. In certain embodiments, the composition is formulatedfor delivery through a needle into a host. Accordingly, the compositionmay be formulated for delivery for injection through a syringe equippedwith a needle, where the end-user resuspends the composition prior touse.

In an embodiment, the antipsychotic agent (e.g., aripiprazole, orolanzapine, or a compound of formula I, II, III, IV or V) can beformulated for modulating tissue reaction associated with the deliveryof a water-insoluble antipsychotic agent. The pharmaceutical compositionhaving reduced injection site reaction can comprise (a) an antipsychoticagent, and (b) sorbitan esters of a carboxylic acid, wherein thecarboxylic acid comprises 8-14 carbon atoms. In a particular embodiment,the sorbitan ester is sorbitan laurate. In an embodiment, thecomposition for injection site modulation can comprise additionalcomponents, such as a polyoxyethylene derivative of a sorbitan ester ofa carboxylic acid, wherein the carboxylic acid comprises 8-14 carbonatoms (e.g., polysorbate 20).

In another embodiment, the modulation of the tissue reaction is areduction in the irritation at the site of injection. In anotherembodiment, the modulation of the tissue reaction is a reduction in theirritation following IM or SC injection. In certain embodiments, thetissue reaction is reduced by at least about 20 percent by weight. Inother embodiments, the tissue reaction is reduced by at least about 10percent by weight.

In one embodiment, the antipsychotic agent is selected from the groupconsisting of aripiprazole, or olanzapine, or a compound of formula I,II, III, IV or V and pharmacologically active salts, hydrates orsolvates thereof

In certain embodiments, the pharmaceutical composition for injectionsite reaction modulation further comprises a buffer. The buffer may beselected from a phosphate, citrate, tartrate or acetate buffer. In aparticular embodiment, the buffer is a phosphate buffer.

In a particular embodiment of the preceding compositions, thecomposition comprises a water-insoluble antipsychotic agent, about0.1-2% percent of sorbitan laurate, about 0.05-1% percent of polysorbate20 and phosphate buffer. In a particular embodiment, the phosphatebuffer comprises isotonic saline with 5-50 mM phosphate buffer at pH5.0-7.5.

In another aspect, provided herein is an injectable compositioncomprising sorbitan laurate, polysorbate 20, phosphate buffer andaripiprazole, or pharmacologically active salts, hydrates, solvates orprodrugs thereof.

In yet another aspect, provided herein is an injectable compositioncomprising sorbitan laurate, polysorbate 20, phosphate buffer andolanzapine, or pharmacologically active salts, hydrates, solvates orprodrugs thereof.

In yet another aspect, provided herein is an injectable compositioncomprising sorbitan laurate, polysorbate 20, phosphate buffer andCompound A-7, or pharmacologically active salts, hydrates, solvates orprodrugs thereof.

Also provided herein is a method for treating disorders of the centralnervous system, comprising administering an effective amount of any ofthe preceding compositions to an individual in need of such treatment.

In one embodiment, the disorder is anxiety or depression. In anotherembodiment, the disorder is bipolar disorder. In still anotherembodiment, the disorder is autism-related irritability. In yet anotherembodiment, the disorder is a psychotic condition. The psychoticcondition may be schizophrenia or schizophreniform diseases.Alternatively, the psychotic condition may be acute mania.

In still another aspect, provided herein is a method of modulatingtissue reaction associated with delivering a water-insolubleantipsychotic agent through a needle into a host, comprising awater-insoluble antipsychotic agent and sorbitan laurate. In oneembodiment of the method, the composition is administered parenterally.In certain embodiments, the composition is administered intradermally,subcutaneously or intramuscularly. In another embodiment of the method,the modulation of the tissue reaction is a reduction in the irritationand the subsequent granuloma formation at the site of injection. In acertain embodiments, the tissue reaction is reduced by at least about 20percent. In other embodiments, the tissue reaction is reduced by atleast about 10 percent. In still another embodiment of the method, thecomposition comprises a water-insoluble antipsychotic agent, about0.1-2% percent of sorbitan laurate, about 0.05-1% percent of polysorbate20 and phosphate buffer.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows results from the settled bed height assessments describedin the experimental section. The data indicate that pharmaceuticalcompositions containing sorbitan laurate and polysorbate 20 havesignificantly higher settled bed heights than compositions withoutsorbitan laurate.

FIG. 2 shows sorbitan laurate's positive effect on settled bed height inpharmaceutical compositions of antipsychotic drugs.

FIG. 3 shows an example photograph illustrating the sediment heightmeasurement on a vial for the pharmaceutical compositions describedherein.

FIG. 4 shows microscopy images of three suspensions made withpharmaceutical compositions containing polysorbate 20 and increasingamounts of sorbitan laurate. It is visually clear that flocculation isoccurring as SML content in the vehicle increases.

FIG. 5 shows vials containing pharmaceutical compositions aftersedimentation with sediment height calculations.

FIG. 6 shows plots of pharmaceutical composition re-suspension time vs.drug particle size. Larger measured suspension particle sizes, caused byflocculation, facilitate faster re-suspension than smaller ones.

FIG. 7 is a contour plot showing amounts of polysorbate 20 and sorbitanlaurate necessary for adequate wetting and re-suspendability.

FIGS. 8A and 8B demonstrate the reduction of tissue reaction associatedwith antipsychotic drugs when the drugs are formulated with sorbitanlaurate.

FIG. 9 demonstrates the results of solubility studies comprising varyingratios of active agent, component (b), and component (c).

DETAILED DESCRIPTION OF INVENTION

Pharmaceutical Compositions

Provided herein is an injectable pharmaceutical composition comprisingan antipsychotic agent and a sorbitan ester of a carboxylic acid,wherein the carboxylic acid comprises 8-14 (e.g., 11-13) carbon atoms. Apreferred sorbitan ester is sorbitan laurate. This composition isparticularly useful for the formulation of a water-insolubleantipsychotic agent into an injectable pharmaceutical composition. Inaddition to a sorbitan ester of a carboxylic acid, the pharmaceuticalcomposition can further comprise a polyoxyethylene derivative of asorbitan ester of a carboxylic acid, wherein the carboxylic acidcomprises 8-14 carbon atoms. In an embodiment, the polyoxyethylenederivative is polysorbate 20. The pharmaceutical composition can furthercomprise and aqueous vehicle, such as phosphate buffered saline, as wellas any of the pharmaceutical components described herein.

The compositions described herein possess a number of advantages. Forexample, the compositions offer minimized excipient levels whileco-optimizing both re-suspendability and acceptable injectability, andmaintain good physiochemical attributes of the antipsychotic agent. Asdescribed in the experimental section, these properties were discoveredbased on comparisons of vehicle performance based on settled bed heightand qualitative ease of resuspension. Briefly, the redispersibility ofthe pharmaceutical compositions were assessed by preparing a number ofdifferent formulations (antipsychotic agent with a variety ofexcipients), and comparing the relative height of the settled beds. Ingeneral, higher settled bed heights are indicative of flocculated, orloosely aggregated, particles. These suspensions settle fasterinitially, but their loosely aggregated state allows for easierredispersion and better physical stability as the particles cannot packas tightly as fully dispersed suspensions, thereby leading to reducedresuspension times using, for example, hand shaking. In one embodiment,the pharmaceutical compositions, e.g., a pharmaceutical composition ofcomponents (a) and (b), or (a), (b) and (c), can be resuspended forinjection within 1-60 seconds of handshaking.

As used herein, the term “flocculation” refers to the formation of aloose aggregation of discrete particles held together in a network-likestructure by physical adsorption of macromolecules, bridging duringchemical interaction (precipitation), or when the longer range van derWaals forces of attraction exceed the shorter range forces ofattraction. (See Pharmaceutical dosage forms: Disperse systems Volume 2.Edited by Herbert A. Lieberman, Martin M. Rieger, and Gilbert S. Banker.(1996) Pg. 18). The “loose aggregation of discrete particles” can bereferred to herein as “flocs.”

As shown in FIG. 1, pharmaceutical compositions containing component (b)(e.g., sorbitan laurate) and component (c) (e.g., polysorbate 20) havesignificantly higher settled bed heights than compositions withoutcomponent (b), regardless of the presence of additional additives (e.g.,polymers) or salts (e.g., phosphate buffer, saline). Additionally, theflocculation induced is unique to component (b)/component (c), asevidenced by comparison to compositions containing sorbitanmonopalmitate, docusate sodium, or polysorbate 20 alone. As describedbelow, the flocculation phenomenon is uniquely attributed to theadditional influence of component (b), e.g., sorbitan laurate.

Accordingly, in one embodiment, provided herein is a compositioncomprising components (a), (b) and (c) at a ratio that results in flocs,wherein the flocs settle to greater than a predetermined sediment bedheight, such that components (a), (b) and (c) can be resuspended forinjection. The flocs can be comprised of component (a), components (a)and (b), or components (a), (b) and (c). A predetermined sediment bedheight refers to a bed height that is higher than the bed height of acomparative pharmaceutical composition that has none of component (b),or none of components (b) or (c). In one embodiment, the bed height iscomprised of at least a 10, 20, 30, 40, 50, 60, 70 or 80% increase insediment height compared to a non flocculated pharmaceutical compositionafter 24 hours of undisturbed sitting. In another embodiment, the bedheight is comprised of at least a 20 to 80% increase in sediment heightcompared to a non flocculated pharmaceutical composition after 24 hoursof undisturbed sitting.

The formed flocs can be any number of sizes. Non-limiting examples ofsizes include Dv[10]: 2-10 μm, Dv[50]: 10-30 μm, and Dv[90]: less than80 μm (e.g., approximately 65 um). In another embodiment, the flocs areDv[10]: 1-10 μm, Dv[50]: 5-30 μm, and Dv[90]: less than 65 μm.

In addition to the re-suspendability and injectability advantagesdescribed above, the pharmaceutical compositions provided herein resultin reduced tissue reactions. Typically, flocculated pharmaceuticalsuspensions have an increased viscosity and reduced flow properties,which impact the ability to inject or administer the product to thepatient. This in turn may negatively impact the local tissue response;therefore it is surprising that the formulations described herein resultin improved tissue response.

Accordingly, in one embodiment, provided herein is a method ofmodulating tissue reactions associated with delivering a water-insolubleantipsychotic agent into a host, comprising the water-insolubleantipsychotic agent and component (b), e.g., sorbitan laurate. Inanother embodiment, the antipsychotic agent/component (b) composition isdelivered to the host through a needle.

Surprisingly, it has been discovered that the composition providedherein results in a decreased tissue reaction normally associated withantipsychotic agents, such as aripiprazole, olanzapine, derivativesthereof, prodrugs thereof, and salts thereof. As demonstrated in theexperimental section, an injectable composition comprising anantipsychotic agent and a sorbitan ester of a carboxylic acid, whereinthe carboxylic acid comprises 8-14 carbon atoms (e.g., sorbitanlaurate), demonstrated an unexpected improvement in tissue reactioncompared to a similar compositions comprising a sorbitan ester of acarboxylic acid falling outside of this range (e.g., sorbitanmonopalmitate). Without being bound by theory, it is believed that afavorable surface interaction between the sorbitan ester of a carboxylicacid (e.g., sorbitan laurate) and the antipsychotic drug (e.g.,aripiprazole or olanzapine) reduces tissue reaction.

Moreover, due to the maximized interaction between these components, theinjectable composition provided herein can be formulated and maintainedin suspension with ease. Surprisingly, it was found that it was easierto formulate the antipsychotic drugs described herein using a sorbitanester of a carboxylic acid, wherein the carboxylic acid comprises 8-14carbon atoms (e.g., sorbitan laurate) compared with other sorbitanesters falling outside of this range (e.g., sorbitan monopalmitate).This was also unexpected. Without being bound by theory, it is believedthat the sorbitan ester component of the injectable composition providedherein improves the hydrophilicity of the drug through surfaceinteractions of the various components. It is additionally noted thatformulation vehicles containing sorbitan laurate and polysorbate 20formed visible emulsions with no oiling out of either surfactant. Incontrast, formulations containing sorbitan palmitate, did not formconsistent emulsions, even with the addition of a second non-ionicsurfactant, with visible undissolved material at the bottom of thematerial.

As used herein, the term “tissue reaction” (TR) refers to foreign bodyresponses to a drug product (active agent and/or vehicle used foradministration). For example, local tissue reaction to drug productresults in the influx of immune cells, the subsequent encapsulation ofthe drug product and usually the development of a fluid filled centralcavity. The presence of fibroblasts, neutrophils, macrophages and giantcells are often observed via histological examination. The term “undueTR” or “unacceptable TR” refers to moderate to severe TR which isunacceptable to the patient and thereby impacts unfavorably on patientcomfort and compliance. The term “reduced TR” refers to generallyminimal to mild TR which is acceptable to the patient and therefore doesnot engender an adverse event related nor impact unfavorably on patientcompliance. As such, the injectable composition provided herein ischaracterized by a decreased undue TR and a more acceptable TR followinginjection of drug product. As used herein, “tissue reaction” can also bereferred to as “injection site reaction.”

The modulation of tissue response following SC administration isdescribed by the reduction of the injection site weight (comprising thedrug depot and surrounding tissue) which provides a quantitativeassessment of the severity of the response. The modulation of the tissueresponse following IM administration is described by the spreadabilityof the drug and resulting depot morphology; spreading of the drug alongthe fascial planes of muscle is desirable rather than the formation of aconcentrated mass of drug in a small area.

Depot morphology resulting from IM injection of aripiprazole andaripiprazole prodrugs has been described. Injections of slow-releasingformulations of drugs, including aripiprazole commonly result in theformation of “cyst-like structures”, characterized by a vascularizedcapsule of roughly spherical shape and comprising various cell types,with or without and a central serous fluid compartment. Tissue responsesto slow-releasing formulations occur as the body mounts an immuneresponse to clear the material from the injection site; this reaction iscommonly referred to as a foreign body response. The spherical nature ofthese reactions can result in localized discomfort and pain, as the FBRincreases in size compressing on nerve fibers innervating muscle tissueand with the release of pro-inflammatory cytokines from the site.

In a particular embodiment, the modulation of the tissue reaction is thereduction in tissue reaction at the site of injection. In oneembodiment, the injection site reaction is reduced by a particularamount, e.g., about 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 5%,etc.

When the antipsychotic agent/sorbitan ester composition is to be used asan injectable composition, including but not limited to injectionthrough a needle or needle-less injection, it can be formulated into aconventional injectable carrier. Suitable carriers include biocompatibleand pharmaceutically acceptable solutions.

Provided below are representative drawings of the sorbitan esters usedin the pharmaceutical compositions described herein. Sorbitan lauratecan also be referred to as “sorbitan monolaurate”:

As described above, the pharmaceutical composition comprising components(a) and (b) can further comprise component (c): a polyoxyethylenederivative of a sorbitan ester of a carboxylic acid, wherein thecarboxylic acid comprises 8-14 carbon atoms. In a particular embodiment,component (c) is polysorbate 20, sold under the trademark TWEEN®. Thepolysorbate can be added in an amount that reduces surface tension of adrug product or aids in suspension stability of the drug product.

Provided below are representative drawings of the polyoxyethylenederivative of a sorbitan ester of a carboxylic acid used in thepharmaceutical compositions:

For compositions comprising components (a), (b), and (c), or (a), (b),(c) and (d), the ratios of (b) and (c) can vary. In one embodiment, theratio of components (b) to (c) is approximately 10 to 0.5, e.g., 10 to1, e.g., 8 to 1, e.g., 5:2, by weight. In another embodiment, the ratioof components (b) to (c) is approximately 5 to 2, by weight. In stillanother embodiment, the composition comprises component (a), sorbitanlaurate, and polysorbate 20, wherein the ratio of sorbitan laurate andpolysorbate 20 is approximately 5 to 2, by weight. In still anotherembodiment, the composition comprises component (a), sorbitan laurate,and polysorbate 20, wherein the ratio of sorbitan laurate andpolysorbate 20 is approximately 3 to 1, by weight. In anotherembodiment, the composition comprises component (a), sorbitan laurate,and polysorbate 20, wherein the ratio of sorbitan laurate andpolysorbate 20 is approximately 2 to 1, by weight. In yet anotherembodiment, the composition comprises component (a), sorbitan laurate,and polysorbate 20, wherein the ratio of sorbitan laurate andpolysorbate 20 is within the range of approximately 3 to 1-2 to 1, byweight.

As described in Table 3, the sorbitan laurate/polysorbate 20 ratio canbe approximately 0.625, 1, 1.25, 2, 2.5, or 5, representing a range of0.625-5.

For compositions comprising components (a) and (b), (a), (b), and (c),or (a), (b), (c) and (d), the weight percent of (b) and (c) can vary. Inone embodiment, the composition comprises about 0.2-1 weight percentcomponent (b), e.g., sorbitan laurate. In another embodiment, thecomposition comprises about 0.4-0.7 weight percent component (b), e.g.,sorbitan laurate. In still another embodiment, the composition comprisesabout 0.5 weight percent component (b), e.g., sorbitan laurate.

In another embodiment, the composition comprises about 0.05-0.8 weightpercent component (c), e.g., polysorbate 20. In yet another embodiment,the composition comprises about 0.1-0.3 weight percent component (c),e.g., polysorbate 20. In still another embodiment, the compositioncomprises about 0.2 weight percent polysorbate 20.

In an embodiment, the ratio of components (b) to (c) is such that thecomposition can be injected using a 20-25 gauge needle. For example, theneedle can be a 20, 21, or 23.5 gauge needle.

The compositions provided herein can also have varying amounts ofantipsychosis agent. The antipsychosis agent can be aripiprazole, orolanzapine, salts of these compounds, hydrates of these compounds,and/or prodrugs of these compounds. In one embodiment, the compositioncomprises approximately 15-35 weight percent aripiprazole, orolanzapine, or a compound of formula I, II, III, IV or V (lurasidone),or pharmaceutically acceptable salts, hydrates, or solvates thereof. Inanother embodiment, the composition comprises approximately 20-30 weightpercent aripiprazole, or olanzapine, or a compound of formula I, II,III, IV or V, or pharmaceutically acceptable salts, hydrates, orsolvates thereof. In still another embodiment, the composition comprisesapproximately 20-26 weight percent aripiprazole, aripiprazole, orolanzapine, or a compound of formula I, II, III, IV or V, orpharmaceutically acceptable salts, hydrates, or solvates thereof. Inanother embodiment, the composition comprises approximately 24-26 weightpercent aripiprazole, or olanzapine, or a compound of formula I, II,III, IV or V, or pharmaceutically acceptable salts, hydrates, orsolvates thereof.

The aqueous vehicle of the pharmaceutical compositions provided hereincan be a buffer. The buffer may be selected from a phosphate, citrate,tartrate or acetate buffer. In a particular embodiment, the buffer is aphosphate buffer.

The pharmaceutical compositions provided herein can further compriseadditional components. For example, the use of additional wetting agentsor surfactants in a pharmaceutical composition may promote one or moreof the following:

(1) Surface tension reduction, which may aid in wetting, since a ‘lowersurface tension’ liquid will wet surfaces or particles more readily thana ‘high surface tension’ liquid. Lowering the surface tension of aliquid may also decrease the incidence of foaming. The surface tensionof a liquid will be lower as more surfactant is added;

(2) Formation of micelles (i.e., spherical or non-spherical surfactantstructures in solution that have the capability to dissolve non-solublecomponents); and/or

(3) Increase of suspension physical stability.

The pharmaceutical compositions can also contain an aqueous vehicle,which is a vehicle that dilutes and suspends the drug. The diluent ofinterest herein is one which is pharmaceutically acceptable (safe andnon-toxic for administration to a human) and is useful for thepreparation of a reconstituted formulation. Exemplary diluents includesterile water, sterile water for injection (WFI), bacteriostatic waterfor injection (BWFI), a pH buffered solution (e.g., phosphate-bufferedsaline), sterile saline solution, Ringer's solution or dextrosesolution. The buffer can be phosphate, citrate, tartrate or acetate. Ina particular embodiment, the diluent is phosphate-buffered saline, whichis a water-based salt solution containing either sodium chloride orpotassium chloride, and sodium phosphate or potassium phosphate. In oneembodiment, the phosphate buffer comprises isotonic saline with 5-50 mMphosphate buffer at pH 4.0-9.0, e.g., 5.0-8.0, e.g., 5.0-7.5.

The pharmaceutical compositions can further contain an additionalsurfactant that preferentially adsorbs to an interface between twoimmiscible phases, such as the interface between water and an organicpolymer solution, a water/air interface or organic solvent/airinterface. Suitable surfactants include but are not limited to fattyalcohols such as polyethylene glycols (PEGs) and cetyl alcohol.

Optionally, the pharmaceutical compositions can further comprise adispersant, such as, for example, carboxymethyl cellulose (CMC),carboxymethyl cellulose sodium, cross-linked sodium carboxymethylcellulose, calcium carboxymethyl cellulose, and low substitutedhydroxypropyl cellulose magnesium aluminum silicate, or a mixturethereof. In a particular embodiment, the pharmaceutical compositioncomprises carboxymethyl cellulose.

The pharmaceutical compositions may also optionally comprise anantioxidant to inhibit the oxidation of ingredients. Some examples ofantioxidants include, but are not limited to, ascorbic acid, ascorbylpalmitate, butylated hydroxyanisole, a mixture of 2 and 3tertiary-butyl-4-hydroxyanisole, butylated hydroxytoluene, sodiumiso-ascorbate, dihydroguaretic acid, potassium sorbate, sodiumbisulfate, sodium metabisulfate, sorbic acid, potassium ascorbate,vitamin E, 4-chloro-2,6-ditertiary butylphenol, alpha-tocopherol, andpropylgallate.

The pharmaceutical compositions can further include a lipid, e.g., aneutral lipid. Neutral lipids include any lipid that remains neutrallycharged at a pH between about 4 and 9. Neutral lipids include, withoutlimitation, cholesterol, other sterols and derivatives thereof,phospholipids, and combinations thereof and other neutral lipids. Thephospholipids include any one phospholipid or combination ofphospholipids capable of forming liposomes. They includephosphatidylcholines, phosphatidylethanolamines, lecithin and fractionsthereof, phosphatidic acid, phosphatidylglycerols,phosphatidylinositols, phosphatidylserines, plasmalogens andsphingomyelins. The phosphatidylcholines include, without limitation,those obtained from egg, soy beans or other plant sources or those thatare partially or wholly synthetic or of variable lipid chain length andunsaturation, POPC, OPPC, natural or hydrogenated soy bean PC, naturalor hydrogenated egg PC, DMPC, DPPC, DSPC, DOPC and derivatives thereof.In one embodiment, phosphatidylcholines are POPC, non-hydrogenated soybean PC and non-hydrogenated egg PC. Phosphatidylethanolamines include,without limitation, DOPE, DMPE and DPPE and derivatives thereof.Phosphatidylglycerols include, without limitation, DMPG, DLPG, DPPG, andDSPG. Phosphatidic acids include, without limitation, DSPA, DMPA, DLPAand DPPA.

The pharmaceutical compositions can also advantageously employ a densityenhancing agent, such as a sugar, e.g., mannitol, or sorbitol and/or atonicity adjusting agent, such as sodium chloride or glycerol.

Other pharmaceutical carriers that could be used in the pharmaceuticalcompositions provided herein also include water, aqueous methylcellulosesolutions, saline, dextrose solutions, fructose solutions, ethanol, oroils of animal, vegetative, or synthetic origin. The pharmaceuticalcarrier may also contain preservatives, and buffers as are known in theart.

The term “pharmaceutical composition”, “formulation”, “injectablecomposition,” etc. are used synonymously throughout the application.

The pharmaceutical compositions described herein may also be in the formof an emulsion. The term “emulsion” as used in this specificationdenotes a two-phase system in which one phase is finely dispersed in theother phase. An emulsifier can be used in the pharmaceuticalcompositions to form the emulsion. The term emulsifier, as used by thisinvention, denotes an agent that can reduce and/or eliminate the surfaceand the interfacial tension in a two-phase system. Such an agentpossesses both hydrophilic and lipophilic groups in the emulsifieragent.

The pharmaceutical compositions described herein may also be in the formof a dispersion. As used herein, the term “dispersion” is to beunderstood as a mixture in which fine particles of one substance (e.g.,a drug) are scattered throughout another substance (e.g., a liquid).Dispersions include suspensions, and colloids.

The methods of the invention include administering the compositionsdescribed herein, thereby obtaining an extended release or sustainedrelease profile in the patient. “Extended-release” or“sustained-release” includes dosage forms whose drug-releasecharacteristics of time course and/or location are chosen to accomplishtherapeutic or convenience objectives not offered by conventional dosageforms such as a solution or an immediate release dosage form. Anextended release profile includes deliveries that achieve atherapeutically effective amount of the antipsychotic agent, e.g.,aripiprazole, or olanzapine, or a compound of formula I, II, III, IV orV, is present in the plasma of the individual for at least about 7 days,preferably at least about 14 days, or more preferably at least about 21days alternatively for at least 2, 3, 4, 6 or 8 weeks or as much asthree months.

In one embodiment, the pharmaceutical compositions can be administeredas a single or sole (undivided) dose. However, the composition is alsouseful for those individuals that require constant or chronic therapy,such as those that receive repeated doses over several hours, days,weeks, months, or more. In such dosing regimens, the method can comprisea first administration of a first extended release composition and asecond administration of a second extended release composition. Thesecond composition can be the same, substantially the same or differentas the first and can include the same active agent or a different activeagent. For example, the second composition can be administered at about7 days, or more, such as at least about 14 days, or at least about 17days, after the first administration, where the first administrationresults in the release of agent for a period of 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, 12, 13, 14 days, or more.

The injectable, pharmaceutical compositions described herein can beinjected into a patient in any number of ways. The term “injectable” asused herein refers to a composition that is suitable to be delivered toan individual in an injection, such as with an injection device,including one that employs a syringe or a cartridge, which may be housedin a manual injection device or an auto-injection device, for example.Specifically, the injectable composition is suitable for parenteraladministration. As used herein, the term “parenteral administration”refers to administration through injection or infusion. Parenteraladministration includes, but is not limited to, intravenousadministration, intradermal administration, subcutaneous administrationor intramuscular administration. The term “intravenous administration”means administration into a vein. “Intradermal administration” isinjection into the upper layer of skin (i.e., the dermis), just beneaththe epidermis. “Subcutaneous administration” refers to administrationjust below the skin. “Intramuscular administration” is the injectiondirectly into a muscle.

Antipsychotic Agents

As discussed above, the pharmaceutical compositions provided herein areuseful for the administration of antipsychotic drugs to a subject. Asused herein the term “antipsychotic” refers all drugs used to treatpsychosis. Common conditions for which antipsychotics are prescribedinclude schizophrenia, mania and delusional disorder, althoughantipsychotics are also used to counter psychosis associated with a widerange of other diagnoses. Antipsychotics also act as mood stabilizersmaking them suitable for the treatment of bipolar disorder (even when nosymptoms of psychosis are present). The pharmaceutical compositionsprovided herein are particularly useful for formulating awater-insoluble antipsychotic into an injectable composition.

The pharmaceutical compositions described herein are useful foradministration of water-insoluble antipsychotic agents. As used herein,a water-insoluble antipsychotic agent is one that dissolves in aquantity of water to an extent of less than 100%. The term“water-insoluble” does not necessarily refer to complete or 100%water-insolubility. In certain embodiments, the water-insoluble materialdissolves to an extent of less than 50%. In other embodiments, thewater-insoluble material dissolves to an extent of less than 10%. In aparticular embodiment, the water-insoluble material dissolves to anextent of less than 1%. The term “water-insoluble” can refer tosolubility as prescribed in the United States Pharmacopoeia.

In one embodiment, the antipsychotic drug of the pharmaceuticalcomposition is aripiprazole. The aripiprazole drug substance cancomprise, consist essentially of, or consist of aripiprazole (in acrystalline, non-crystalline or amorphous form), an aripiprazole salt,an aripiprazole solvate (including ethanolates and hydrates), or otheraripiprazole polymorphs. Preferred salts include those salts insolublein an aqueous vehicle. Pharmaceutical salts such as the hydrochlorideand various pharmaceutically acceptable carboxylate salts are suitable.

The aripiprazole drug substance can also include aripiprazole prodrugs.The term “prodrug” is art-recognized and is intended to encompasscompounds which, under physiological conditions, are converted intoactive compounds, e.g., those described herein. A common method formaking a prodrug is to select moieties which are hydrolyzed or otherwisecleaved under physiological conditions to provide the desired compound.In other embodiments, the prodrug is converted by an enzymatic activityof the host animal.

Preferred aripiprazole prodrugs that can be used in the pharmaceuticalcompositions include the prodrugs described in U.S. Publication No.2011/0003828, which is incorporated herein by reference in its entirety.

In a particular embodiment, the aripiprazole prodrug is a compound offormula (I) or formula (II):

wherein

R^(a) is absent, and R^(b) is —CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂or —C(O)R¹;

or

R^(b) is absent, and R^(a) is —CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂or —C(O)R¹;

R^(c) is —CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹;

wherein each R¹ is independently selected from the group consisting ofhydrogen, substituted or unsubstituted aliphatic, and substituted orunsubstituted aryl; and

wherein each R² is selected from the group consisting of substituted orunsubstituted aryl and substituted or unsubstituted heteroaryl;

wherein Y^(⊖) is a pharmaceutically acceptable counterion; and

wherein

represents a single or double bond.

Suitable counterions include, e.g., chloride, bromide, iodide, sulfate,phosphate, acetate, benzoate, tartrate, citrate, propionate, gluconate,lactate, maleate, fumarate, camsylate, glucepate, mesylate, napsylate,pamoate, conjugate bases of organic carboxylic acids, and the like.

In one embodiment of formula (I), the aripiprazole prodrug is a compoundof formula (I′):

wherein R^(a) is CH₂OC(O)R¹ and wherein R¹ is selected from substitutedor unsubstituted aliphatic.

In a particular embodiment of formula (I′), R¹ is —CH₂OC(O)—(CH₂)₄CH₃(Compound A-4). In another particular embodiment of formula (I′), R¹ is—CH₂OC(O)—(CH₂)₁₀CH₃ (Compound A-7). Compounds A-4 and A-7 are depictedbelow:

In another embodiment, the antipsychotic drug of the pharmaceuticalcomposition is olanzapine. The olanzapine drug substance can comprise,consist essentially of, or consist of olanzapine (in a crystalline,non-crystalline or amorphous form), an olanzapine salt, an olanzapinesolvate (including for example ethanolates and hydrates), or otherolanzapine polymorphs. A preferred olanzapine salt is olanzapinepamoate. The antipsychotic drug can also be an olznapine prodrug.

The olanzapine drug substance can also include olanzapine prodrugs ofFormula (III), or (IV):

wherein

R³ is —CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹;

R⁴ is —CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹;

wherein each R¹ is independently selected from the group consisting ofhydrogen, substituted or unsubstituted aliphatic, and substituted orunsubstituted aryl; and

wherein Y^(⊖) is a pharmaceutically acceptable counterion.

Suitable counterions include, e.g., chloride, bromide, iodide, sulfate,phosphate, acetate, benzoate, tartrate, citrate, propionate, gluconate,lactate, maleate, fumarate, camsylate, glucepate, mesylate, napsylate,pamoate, conjugate bases of organic carboxylic acids, and the like.

In another embodiment, the antipsychotic drug of the pharmaceuticalcompositions is lurasidone. Lurasidone is an atypical antipsychotic thatis useful for the treatment of a variety of psychiatric disorders,including schizophrenia and bipolar disorder. This compound is describedin, e.g., U.S. Pat. No. 5,532,372, which is incorporated herein byreference. Lurasidone is the generic name of the compound(3aR,4S,7R,7aS)-2-[((1R,2R)-2-{[4-(1,2-benzisothiazol-3-yl)-piperazin-1-yl]methyl}cyclohexyl)methyl]hexahydro-1H-4,7-methanisoindol-1,3-dione:

The lurasidone drug substance can comprise, consist essentially of, orconsist of lurasidone free base (in a crystalline, non-crystalline oramorphous form), a lurasidone salt, a lurasidone solvate (including forexample ethanolates and hydrates), or other lurasidone polymorphs. Thelurasidone drug substance can also include lurasidone prodrugs.

Accordingly, aripiprazole, or olanzapine, or a compound of formula I,II, III, IV, or V can be referred to as an “antipsychotic agent” or“water-insoluble antipsychotic agent.”

An “aliphatic group” or “aliphatic” is non-aromatic moiety that may besaturated (e.g. single bond) or contain one or more units ofunsaturation, e.g., double and/or triple bonds. An aliphatic group maybe straight chained, branched or cyclic, contain carbon, hydrogen or,optionally, one or more heteroatoms and may be substituted orunsubstituted.

An aliphatic group, when used as a linker, preferably contains betweenabout 1 and about 24 atoms, more preferably between about 4 to about 24atoms, more preferably between about 4 to about 12 atoms, more typicallybetween about 4 and about 8 atoms. An aliphatic group, when used as asubstituent, preferably contains between about 1 and about 30 atoms,more preferably between about 4 to about 19 atoms. In addition toaliphatic hydrocarbon groups, aliphatic groups include, for example,polyalkoxyalkyls, such as polyalkylene glycols, polyamines, andpolyimines, for example. Such aliphatic groups may be furthersubstituted. It is understood that aliphatic groups may include alkyl,substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substitutedalkynyl groups described herein.

In certain embodiments, the aliphatic groups of the present inventionare alkyl chains containing from 5 to 11 carbon atoms. In otherembodiments, the aliphatic groups are alkyl chains containing from 15 to19 carbon atoms.

The term “aryl”, alone or in combination, means a carbocyclic aromaticsystem containing one, two or three rings wherein such rings may beattached together in a pendent manner or may be fused. The term “aryl”embraces aromatic radicals such as phenyl, naphthyl, tetrahydronaphthyl,indane and biphenyl. In an embodiment, aryl is unsubstituted orindependently substituted one or more times with halogen, C₁₋₆ alkyl, orO—C₁₋₆ alkyl.

The term “heteroaryl” embraces unsaturated heterocyclyl radicals.Examples of heteroaryl radicals include unsaturated 3 to 6 memberedheteromonocyclic group containing 1 to 4 nitrogen atoms, for example,pyrrolyl, pyrrolinyl, imidazolyl, pyrazolyl, pyridyl, pyrimidyl,pyrazinyl, pyridazinyl, triazolyl (e.g., 4H-1,2,4-triazolyl,1H-1,2,3-triazolyl, 2H-1,2,3-triazolyl, etc.) tetrazolyl (e.g.1H-tetrazolyl, 2H-tetrazolyl, etc.), etc.; unsaturated condensedheterocyclyl group containing 1 to 5 nitrogen atoms, for example,indolyl, isoindolyl, indolizinyl, benzimidazolyl, quinolyl, isoquinolyl,indazolyl, benzotriazolyl, tetrazolopyridazinyl (e.g.,tetrazolo[1,5-b]pyridazinyl, etc.), etc.; unsaturated 3 to 6-memberedheteromonocyclic group containing an oxygen atom, for example, pyranyl,furyl, etc.; unsaturated 3 to 6-membered heteromonocyclic groupcontaining a sulfur atom, for example, thienyl, etc.; unsaturated 3- to6-membered heteromonocyclic group containing 1 to 2 oxygen atoms and 1to 3 nitrogen atoms, for example, oxazolyl, isoxazolyl, oxadiazolyl(e.g., 1,2,4-oxadiazolyl, 1,3,4-oxadiazolyl, 1,2,5-oxadiazolyl, etc.)etc.; unsaturated condensed heterocyclyl group containing 1 to 2 oxygenatoms and 1 to 3 nitrogen atoms (e.g. benzoxazolyl, benzoxadiazolyl,etc.); unsaturated 3 to 6-membered heteromonocyclic group containing 1to 2 sulfur atoms and 1 to 3 nitrogen atoms, for example, thiazolyl,thiadiazolyl (e.g., 1,2,4-thiadiazolyl, 1,3,4-thiadiazolyl,1,2,5-thiadiazolyl, etc.) etc.; unsaturated condensed heterocyclyl groupcontaining 1 to 2 sulfur atoms and 1 to 3 nitrogen atoms (e.g.,benzothiazolyl, benzothiadiazolyl, etc.) and the like.

The term “substituted” refers to the replacement of one or more hydrogenradicals in a given structure with the radical of a specifiedsubstituent including, but not limited to: halo, alkyl, alkenyl,alkynyl, aryl, heterocyclyl, thiol, alkylthio, arylthio, alkylthioalkyl,arylthioalkyl, alkylsulfonyl, alkylsulfonylalkyl, arylsulfonylalkyl,alkoxy, aryloxy, aralkoxy, aminocarbonyl, alkylaminocarbonyl,arylaminocarbonyl, alkoxycarbonyl, aryloxycarbonyl, haloalkyl, amino,trifluoromethyl, cyano, nitro, alkylamino, arylamino, alkylaminoalkyl,arylaminoalkyl, aminoalkylamino, hydroxy, alkoxyalkyl, carboxyalkyl,alkoxycarbonylalkyl, aminocarbonylalkyl, acyl, aralkoxycarbonyl,carboxylic acid, sulfonic acid, sulfonyl, phosphonic acid, aryl,heteroaryl, heterocyclic, and aliphatic. It is understood that thesubstituent may be further substituted.

For simplicity, chemical moieties that are defined and referred tothroughout can be univalent chemical moieties (e.g., alkyl, aryl, etc.)or multivalent moieties under the appropriate structural circumstancesclear to those skilled in the art. For example, an “alkyl” moiety can bereferred to a monovalent radical (e.g. CH₃—CH₂—), or in other instances,a bivalent linking moiety can be “alkyl,” in which case those skilled inthe art will understand the alkyl to be a divalent radical (e.g.,—CH₂—CH₂—), which is equivalent to the term “alkylene.” Similarly, incircumstances in which divalent moieties are required and are stated asbeing “alkoxy”, “alkylamino”, “aryloxy”, “alkylthio”, “aryl”,“heteroaryl”, “heterocyclic”, “alkyl” “alkenyl”, “alkynyl”, “aliphatic”,or “cycloalkyl”, those skilled in the art will understand that the termsalkoxy”, “alkylamino”, “aryloxy”, “alkylthio”, “aryl”, “heteroaryl”,“heterocyclic”, “alkyl”, “alkenyl”, “alkynyl”, “aliphatic”, or“cycloalkyl” refer to the corresponding divalent moiety.

The term “compound” is defined herein to include pharmaceuticallyacceptable salts, solvates, hydrates, polymorphs, enantiomers,diastereoisomers, racemates and the like of the compounds having aformula as set forth herein.

Methods of Treatment

The pharmaceutical compositions provided herein can be used fortreatment of a variety of disorders in a subject in need thereof. Forexample, the disclosed compositions may be used to treat conditionsselected from: disorders such as cerebral deficit subsequent to cardiacbypass surgery and grafting, stroke, cerebral ischemia, spinal cordtrauma, head trauma, perinatal hypoxia, cardiac arrest, hypoglycemicneuronal damage, dementia (including AIDS-induced dementia), Alzheimer'sdisease, Huntington's Chorea, amyotrophic lateral sclerosis, oculardamage, retinopathy, cognitive disorders, idiopathic and drug-inducedParkinson's disease, muscular spasms and disorders associated withmuscular spasticity including tremors, epilepsy, convulsions, cerebraldeficits secondary to prolonged status epilepticus, migraine (includingmigraine headache), urinary incontinence, substance tolerance, substancewithdrawal (including, substances such as opiates, nicotine, tobaccoproducts, alcohol, benzodiazepines, cocaine, sedatives, hypnotics,etc.), psychosis, schizophrenia, anxiety (including generalized anxietydisorder, panic disorder, social phobia, obsessive compulsive disorder,and post-traumatic stress disorder (PTSD)), attention deficit disorder(ADD), attention deficit hyperactivity disorder (ADHD), mood disorders(including depression, mania, bipolar disorders), circadian rhythmdisorders (including jet lag and shift work), trigeminal neuralgia,hearing loss, tinnitus, macular degeneration of the eye, emesis, brainedema, pain (including acute and chronic pain states, severe pain,intractable pain, neuropathic pain, inflammatory pain, andpost-traumatic pain), tardive dyskinesia, sleep disorders (includingnarcolepsy), attention deficit/hyperactivity disorder, and conductdisorder.

In another embodiment, the present invention provides a method oftreating cardiac and cardiovascular disorders such as angina,arrhythmia, and hypertension, in a patient in need thereof. The methodcomprises administering to the subject a therapeutically effectiveamount of a composition of the invention or a pharmaceuticallyacceptable salt thereof.

The invention further relates to the treatment of fever, diabetes,allergy, asthma, infection, inflammation, and ulcers in a patient inneed thereof, comprising administering to the subject a therapeuticallyeffective amount of a composition of the invention or a pharmaceuticallyacceptable salt thereof.

The invention further relates to the treatment of sleep modulationcomprising administration of a composition of the invention. Sleepmodulation includes decreasing the time to sleep onset, increasing theaverage sleep bout length, and increasing the maximum sleep bout length.

In a particular embodiment, the pharmaceutical compositions describedherein can be used to treat anxiety, depression, bipolar disorder,autism-related irritability, and psychotic conditions including acutemania, schizophrenia and schizophreniform diseases in a subject.

The term “treated,” “treating” or “treatment” includes the diminishmentor alleviation of at least one symptom associated with psychosis or arelated CNS disorder. The term “treated,” “treating” or “treatment” asused in reference to a disease or condition shall mean to intervene insuch disease or condition so as to prevent or slow the development of,prevent or slow the progression of, halt the progression of, oreliminate the disease or condition.

As used herein, the term “modulating” or “modulate” refers to an effectof altering a biological activity, especially a biological activityassociated with an injection site reaction.

The term “subject” is intended to include animals, which are capable ofsuffering from or afflicted with dementia associated with psychosis or arelated CNS disorder, including, without limitation, psychoticconditions including acute mania, schizophrenia and schizophreniformdisorders, bipolar disorder, anxiety and depression. Examples ofsubjects include mammals, e.g., humans, dogs, cows, horses, pigs, sheep,goats, cats, mice, rabbits, rats, and transgenic non-human animals. Incertain embodiments, the subject is a human, e.g., a human sufferingfrom, at risk of suffering from, or potentially capable of sufferingfrom any of the diseases described herein.

The term “about” or “approximately” usually means within 20%, morepreferably within 10%, and most preferably still within 5% of a givenvalue or range. Alternatively, especially in biological systems, theterm “about” means within about a log (i.e., an order of magnitude),preferably within a factor of two of a given value.

In one embodiment, a therapeutically effective amount of the agent isgiven to a subject using the pharmaceutical compositions providedherein. The term “therapeutically effective amount” is further meant todefine an amount resulting in the improvement of any parameters orclinical symptoms. The actual dose may vary with each patient and doesnot necessarily indicate a total elimination of all disease symptoms. Inthe case of antipsychotics, the management of exacerbations andmaintenance of remission of psychiatric symptoms are main goals oftherapy, and selection of the appropriate drug and dosage in aparticular disease balances these goals with the minimization of adverseevents attributable to the drug.

A therapeutically effective amount of the compound used in the treatmentdescribed herein can be readily determined by the attendingdiagnostician, as one skilled in the art, by the use of conventionaltechniques and by observing results obtained under analogouscircumstances. In determining the therapeutically effective dose, anumber of factors are considered by the attending diagnostician,including, but not limited to: the species of mammal; its size, age, andgeneral health; the specific disease involved; the degree of orinvolvement or the severity of the disease; the response of theindividual patient; the particular compound administered; the mode ofadministration; the bioavailability characteristic of the preparationadministered; the dose regimen selected; the use of concomitantmedication; and other relevant circumstances.

Preferred suitable dosages for the compounds used in the treatmentdescribed herein are on the order of about 1 mg to about 600 mg,preferably about 3, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65,70, 75, 80, 90, 95, 100, 120, 140, 160, 180, 200, 220, 240, 260, 280,300, 320, 340, 360, 380, 400, 420, 440, 460, 480, 500, 520, 540, 560,580 to about 600 mgs total of active agent. Dosing schedules may beadjusted to provide the optimal therapeutic response. For example,administration can be one to three times daily for a time course of oneday to several days, weeks, months, and even years, and may even be forthe life of the patient. Practically speaking, a unit dose of any givencomposition used in the treatment described herein can be administeredin a variety of dosing schedules, depending on the judgment of theclinician, needs of the patient, and so forth. The specific dosingschedule will be known by those of ordinary skill in the art or can bedetermined experimentally using routine methods. Exemplary dosingschedules include, without limitation, administration five times a day,four times a day, three times a day, twice daily, once daily, everyother day, three times weekly, twice weekly, once weekly, twice monthly,once monthly, and so forth. Unit dose preparations provided herein cancontain aripiprazole, a compound of Formula I or a compound of FormulaII in the range of about 20 to about 900, e.g., 60 to about 800, mgs(aripiprazole base equivalents). Unit dose preparations provided hereincan contain olanzapine, a compound of Formula III, or a compound ofFormula IV in the range of 40 to about 500 mgs (olanzapine baseequivalents). Unit dose preparations provided herein can contain acompound of Formula V in the range of 160 to about 1000 mgs (lurasidonebase equivalents).

Preferred amounts according to the selected mode of administration areable to be determined by one skilled in the art. Pharmaceuticalcompositions can be manufactured utilizing techniques known in the art.Typically the therapeutically effective amount of the compound will beadmixed with a pharmaceutically acceptable carrier.

EXEMPLIFICATION OF THE INVENTION

The invention is further illustrated by the following examples. Theexamples should not be construed as further limiting.

EXAMPLE I Formulation Optimization of Antipsychotic Drug Product

This study describes the formulation development of the Compound A-7drug product for use in further studies. Development was focused onimproving the wettability and redispersibility characteristics of theinjection vehicle, with the ultimate intent of increasing the physicalstability of the suspension. The optimization experiments identified aformulation comprising Compound A-7 recrystallized bulk drug substance(256 mg/mL) suspended in an 10 mM phosphate buffer injection vehiclecontaining sorbitan laurate (0.5 wt %), polysorbate 20 (0.2 wt %), andsodium chloride, (0.8 wt %).

While the early clinical formulation was deemed acceptable forshort-term study, there was a desire to improve the physical propertiesof the drug product suspension (namely ease of manufacturing, andresuspendability with increased drug loads) for long term use.Optimization of these properties would also improve the likelihood ofsuccess in a prefilled syringe, in the event such a system becomes adesired container closure configuration. The strategy for formulationdevelopment consisted of a two-tiered approach designed to screen a widearray of injection vehicles and identify promising candidates forfurther optimization. The first round of experiments assessedwettability characteristics, specifically free energy of immersion andspreading coefficient, of various vehicles with Compound A-7 Immersionof a solid in a liquid (wetting) begins with displacement of thesolid-air interface with a solid-liquid interface. The immersional freeenergy in this solid/liquid/air system describes how thermodynamicallyfavorable (or unfavorable) exchange of these interfaces is. Thespreading coefficient predicts whether this exchange will occurspontaneously, or will require additional energy input. Thus, theseparameters were selected for study since they would be good indicatorsof the favorability of the vehicles to wet the hydrophobic drugsubstance, and the relative difficulty of doing so. The excipientsscreened were primarily limited to materials that have been used inapproved drug products (although not necessarily limited to parenteralroutes of administration) with acceptable safety profiles [Rowe, RaymondC., Paul J. Sheskey, and Paul J Weller. Handbook of PharmaceuticalExcipients, 4th Ed. New York, Pharmaceutical Press. 2003]. Theexcipients screened represent a number of functionalities in theformulation of stable suspensions, including suspending agents,surfactants/wetting agents, viscosity modifiers, co-solvents andflocculants. The injection vehicles that were found to have favorablewetting characteristics with Compound A-7 were then advanced to thesecond tier of experiments.

Description of Excipients Utilized

ABBRE- TRADE MANU- MATERIAL VIATION NAME(S) FACTURER Sodium CMC N/ASpectrum carboxymethyl cellulose Poloxamer 188 P188 Pluronic ® F68Spectrum Polyvinylpyrrolidone PVP, Povidone Plasdone ® K- K15 15Polyvinylpyrrolidone N/A Plasdone ® K- Sigma USP K30 30 Polyethyleneglycol PEG3350 N/A Sigma 3350 Polyethylene PEG 300 N/A Emerald Bioglycol 300 Polysorbate 20 PS 20 Tween ® 20 Sigma Polysorbate 80 PS 80Tween ® 80 EMD Sorbitan monolaurate SML Span ® 20, Sigma-AldrichMontane ® 20 Sorbitan SMP Span ® 40 Aldrich monopalmitate Sodiumchloride NaCl N/A EMD Mannitol N/A N/A Merck Dextrose N/A N/ASigma-Aldrich Monobasic sodium N/A N/A EMD phosphate (dihydrate) Dibasicsodium N/A N/A J. T. Baker phosphate (anhydrous) Phosphate buffered PBSN/A Sigma saline tablets* Docusate sodium N/A N/A Sigma *One tabletdissolved in 200 mL of deionized water yields 0.01M phosphate buffer,0.0027M potassium chloride and 0.137M sodium chloride, pH 7.4, at 25° C.5.2 Methods5.2.2 Injection Vehicle Formulation

Injection vehicles were made by weighing the appropriate mass ofexcipient into a metered volume of water for injection (WFI) to give thedesired weight percentage by volume. Since the excipient quantities weretypically low (<1%), the volume change from addition was considerednegligible. In the cases where multiple surfactants were added, the morewater-soluble surfactant was added first to aid in dispersion of theless soluble surfactant. The vehicle formulations were then stirred witha magnetic stir plate until all solids were dissolved and the vehicleappeared visually homogeneous.

5.2.3 Compound A-7 Drug Product Compounding

The suspension was formed by adding recrystallized Compound A-7 to theformulated injection vehicle with mixing to achieve the target drugconcentration. At the bench scale, this was done on a vial-by-vialbasis. The appropriate mass of Compound A-7 was weighed into a 5 mLsiliconized glass vial and the appropriate volume of vehicle was addedto achieve the desired suspension concentration. The vial was thenstoppered/sealed and mixed by alternating between a vortex mixer and a60 second sonication bath. This procedure was typically repeated 7 times(total of 7 minutes). After compounding, the absence of aggregates orunincorporated powder was visually confirmed.

5.2.5 Wettability Characterization

A surface energy measurement methodology was developed that would allowfor facile screening of formulation candidates with minimal use of drugsubstance. These experiments utilize the surface tension of theinjection vehicle and surface energy of the solid to predict theimmersional free energy and spreading coefficient between the liquid andthe solid.

5.2.6 Liquid Surface Tension Analysis

A force-balance tensiometer (Attension Sigma® 701) with a platinumWilhelmy plate was used to measure the surface energy (tension) of thevehicle of interest. This was done using a 30 mL sample of the vehicleof interest and taking 8 individual surface tension measurements. Thefirst 3 measurements were discarded as being non-representative ofequilibrium conditions, and the remaining measurements were averaged togive the surface tension value. The vehicle sample contained a small(approx. 10 mm) stir bar and the magnetic stir plate in the tensiometerwas turned to the lowest setting to allow for mixing without significantdisruption of the measurement. All measurements were taken at ambientconditions. To then obtain the polar and non-polar (dispersive)components of the surface tension, a polytetrafluoroethylene (PTFE)contact angle standard (Rame-Hart) was affixed to the tensiometer andthe dynamic contact angle was measured. Since the desired measurementwas the static contact angle, a very slow measurement speed was used(0.001 m/min) which allowed for approximation of the t→∞ (infinite time)condition. This was done using a 30 mL sample of the vehicle of interestand taking the average of 3 individual contact angle measurements. Thevehicle sample contained a small (approx. 10 mm) stir bar and themagnetic stir plate in the tensiometer was turned to the lowest settingto allow for mixing without significant disruption of the measurement.All measurements were taken at ambient conditions.

With the total surface tension of the liquid, and the contact angle ofthe liquid on a non-polar surface with known surface energy attributes,the polar and dispersive components of the surface tension werecalculated.

5.2.7 Solid Surface Energy Analysis

A force balance tensiometer (Kruss K100) with a Washburn-type powdermeasurement apparatus (Kruss FL12) was used to obtain the polar anddispersive surface energy components of the Compound A-7 sample. Thiswas done by using probe liquids with precisely characterized surfacetensions (diiodomethane and ethylene glycol) and measuring the rate atwhich the probe liquids wick up into a packed, 125 mg bed of the powderby capillary action. The contact angle experiments were performed on thesamples according to the Washburn method for the determination ofcontact angles for liquids wetting porous materials. The contact angledata with diiodomethane and ethylene glycol were used along with theFowkes theory to obtain the surface energy data.

5.2.8 Redispersibility/Settled Bed Height Characterization

The redispersibility of the drug products were assessed by creating lowconcentration suspensions and comparing the relative height of thesettled beds. Higher settled bed heights are indicative of flocculated,or loosely aggregated, particles. These suspensions settle fasterinitially, but their loosely aggregated state allows for easierredispersion and better physical stability as the particles cannot packas tightly as fully dispersed suspensions.

The experiments were made using a concentration of 220±22 mg of CompoundA-7 in 3 mL of the vehicle of interest (73.3 mg/mL). The lowerconcentration was used to allow for easier rank ordering of settled bedheights as well as for material conservation. A key assumption was thatthis rank ordering would be the same at full concentration. Thissuspension was compounded in a 5 mL vial, drawn into a 3 mL BD plasticsyringe using an 18G needle, capped, placed upright and allowed tosettle. Early experiments showed that suspensions were fully settledafter approximately 10 hours, and that subsequent time did not result inany discernable amount of further bed packing. As such, all suspensionstested were allowed to settle for a minimum of 16 h and a maximum of 48h prior to being characterized.

Settled bed heights were assessed by qualitatively recording the heightof the undisturbed bed and total height of the liquid using thegraduations on the 3 mL syringes. Formulations that looked promising(highest bed heights) at lower concentrations were also screened at fullconcentration (810 mg in 3 mL—equivalent to 270 mg per mL vehicle) toqualitatively assess redispersibility.

6.0 Results and Discussion

TABLE 1 Free Energy of Immersion and Spreading Coefficient of CompoundA-7 in Various Formulations FREE ENERGY OF SPREADING IMMERSIONCOEFFICIENT FORMULATION (mN/m) (mN/m) 2% CMC - 0.2% PS 20 −30 −0.6 2%PEG3350 - 0.2% PS 20 - 2% Eth −30 −3.8 0.2% Docusate Sodium −30 1.2 4%PEG3350 - 0.8% SML - 0.5% PS 20 −29 2.6 0.8% SML - 0.5% PS 20 −29 2.3 4%PEG 3350 - 0.2% PS 20 −29 −6.1 2% PEG 3350 - 0.2% PS 20 −28 −5.6 2%PEG3350 - 0.2% PS 20 - 1% Eth −29 −6.1 2% CMC - 0.2% PS 20 - PBS - (SAD)−28 −5.5 6% PEG3350 - 0.2% PS 20 −28 −6.6 2% CMC - 0.2% PS 80 −28 −6.74% PEG 3350 - 0.5% PS 20 −27 −6.5 1% CMC - 0.8% SML - 0.5% PS 20 −27 0.82% CMC - 0.5% PS 20 −26 −7.3 40% PEG 300 −23 −19.6 4% PEG 3350 −23 −37.52% PEG 3350 −22 −34.8 2% CMC - 0.2% Poloxamer 188 −21 −25.2 0.8% SMP -0.5% PS 20 −19 −13.1 1% CMC - 0.8% SMP - 0.5% PS 20 −17 −14.6 2% PVP K30−12 −47.5 2% PVP K15 −8 −60.0 Water 10 −83.3

As shown in Table 1, the free energy of immersion for all formulationstested against all recrystallized Compound A-7 samples was found to benegative, with the exception of pure water. Free energy of immersiondescribes the energy gained or lost when displacing the air-solidinterface with a liquid-solid interface. If the sign is negative, theliquid-solid interface (created by wetting) is more energeticallyfavorable, and if the sign is positive, the air-solid interface is moreenergetically favorable. Examination of the data shows that formulationscontaining sorbitan laurate, polysorbate 20 and polysorbate 80 are themost favored (most negative free energy of immersion value).

While all vehicle formulations tested have thermodynamically favorableimmersional free energies, the data in Table 1 illustrate thatformulations are differentiated by their spreading coefficients. Thevalue of spreading coefficient indicates whether the replacement of theair-solid interface by the liquid-solid interface will occurspontaneously. The results show that vehicle formulations containingdocusate sodium and sorbitan laurate/polysorbate 20 combinations havepositive spreading coefficients, which means they will replace thesolid-air interface with the solid-liquid interface without the additionof work (i.e. spreading occurs spontaneously). A positive spreadingcoefficient is desirable because of an increased likelihood of completedeaggregation/wetting of the powder during suspension compoundingleading to an overall ease of processing.

In summary, while analysis of the wetting data show that practically allformulations are predicted to wet, with the most favored formulationscontaining a surfactant such as polysorbate 20, polysorbate 80, sorbitanlaurate or docusate sodium, review of the spreading coefficient dataidentified formulations that are spontaneously wetting. The latter haspositive implications for processing ease and robustness. As such, thesematerials were selected as the area of focus in the subsequentredispersibility studies discussed in Section 6.4.

6.4 Redispersibility/Settled Bed Height

The results from the settled bed height assessments are presented inFIG. 1. The data indicate that formulations containing sorbitan laurateand polysorbate 20 have significantly higher settled bed heights thanformulations without sorbitan laurate, regardless of the presence ofadditional polymers (CMC, PEG 3350) or salts (phosphate buffer, saline).Additionally, the flocculation induced is unique to sorbitanlaurate/polysorbate 20, as evidenced by comparison to formulationscontaining sorbitan monopalmitate, docusate sodium, or polysorbate 20alone.

Experiments were also performed to assess whether the inducedflocculation could be uniquely attributed to the presence of sorbitanlaurate, or whether it was the result of an increase in total surfactantload. Suspensions were made with an equivalent mass load of polysorbate20 and polysorbate 80 (1.3 wt %) and an equivalent molar content load ofpolysorbate 20 (3.1 wt %) to the total surfactant load of a 0.5%sorbitan laurate/0.2% polysorbate 20 suspension. The suspensions withincreased polysorbate 20 were found to have similar settled bed heightsto 0.2 wt % polysorbate formulations, showing the flocculationphenomenon to be uniquely attributed to the additional influence ofsorbitan laurate.

Compared with other formulations, the sorbitan laurate/polysorbate 20formulations resuspend more easily after settling, and as such thesesuspensions were made at the full concentration of 21 wt %. At fullconcentration settled bed heights could not be measured as theflocculated bed filled the entirety of the syringe volume. Qualitativeassessment of redispersibility showed the settled bed to be easilydisrupted with moderate hand shaking of the vials.

In an effort to optimize the ratio between sorbitan laurate andpolysorbate 20, suspensions were made in 0.2% polysorbate 20 withphosphate buffered saline and the amount of sorbitan laurate variedbetween 0.2% and 0.6% (representing sorbitan laurate: polysorbate 20ratios from 1:1 to 3:1). The results are shown in FIG. 2. The settledbed height increases to a maximum at a 2:1 ratio, after which,increasing sorbitan laurate concentration has no further effect on bedheight. In order to select a formulation in a robust formulation space,the 10 mM phosphate buffer injection vehicle containing sorbitan laurate(0.5 wt %), polysorbate 20 (0.2 wt %), and sodium chloride, (0.8 wt %)was selected as the lead candidate and advanced into further studies.

7.0 Example I Conclusion

The optimized Compound A-7 drug product (Compound A-7 recrystallizedbulk drug substance suspended in an 10 mM phosphate buffer injectionvehicle containing sorbitan laurate (0.5 wt %), polysorbate 20 (0.2 wt%), and sodium chloride, (0.8 wt %)) was found to meet all targetcriteria and exhibits improved physical attributes (redispersibility,ease of wetting) when compared to the Compound A-7 recrystallized bulkdrug substance (21 wt %) suspended in an 5 mM phosphate buffer injectionvehicle containing sodium carboxymethyl cellulose (2 wt %), polysorbate20 (0.2 wt %), and sodium chloride, (0.7 wt %). The optimizedformulation is physically and chemically stable when compounded as a 21wt % suspension (approximately 221 mg/mL) and as a 25.6 wt % suspension(approximately 270 mg/mL).

EXAMPLE II Evaluation of Performance of Compound A-7 SuspensionsContaining Varied Amounts of Sorbitan Laurate and Polysorbate 20:Optimization of Excipient Concentrations and Sorbitan Laurate toPolysorbate 20 Ratio

The objective of this study was to evaluate formulation performance ofCompound A-7 suspensions containing varied amounts and ratios ofsorbitan laurate and polysorbate 20 in an effort to establish a robustregion for the drug product which meets all target product attributes.

An array of vehicle formulations were evaluated and a lead drug productcandidate consisting of Compound A-7 bulk recrystallized drug substance(25.6 wt %) suspended in an 10 mM phosphate buffer injection vehiclecontaining sorbitan laurate (0.5 wt %), polysorbate 20 (0.2 wt %), andsodium chloride, (0.8 wt %) was identified.

During development, settled bed height and qualitative ease ofre-suspension were assessed and utilized to identify a lead formulation.Increases in these properties are associated with flocculation, a commonmechanism used to increase physical stability of pharmaceuticalsuspensions [Akers, M., Fites, A. and Robison, R. Formulation Design andDevelopment of Parenteral Suspensions. Journal of Parenteral Science andTechnology Vol. 41, No. 3 (pp. 88-96), 1987; and Lieberman, Herbert A.,Martin M. Reiger and Gilbert S. Banker. Pharmaceutical Dosage Forms:Disperse Systems Volume 2. (pp 18-22, 285-301) 2nd Ed. New York: MarcelDekker, 1996.]. Flocculation refers to the formation of loose aggregatesheld together by interparticular forces. The sediment layer in aflocculated suspension is loosely packed and more easily redispersedcompared to non-flocculated formulations in which a dense cake can form.Further experiments to quantify flocculation and formulation performancewith vehicles containing varied amounts of sorbitan laurate andpolysorbate 20 were designed, executed and analyzed. These follow-onexperiments are detailed below.

5.2 Methods

TABLE 2 Amounts and Ratios of Surfactanct Components in VehiclesExamined Sorbitan Monolaurate Polysorbate 20 Nominal Mass Ratio Vehicle(g/100 mL) (g/100 mL) SML/PS20 A 0 0.1 0 B 0 0.2 0 C 0 0.5 0 D 0 0.8 0 E0.5 0.1 5 F 0.5 0.2 2.5 G 0.5 0.5 1 H 0.5 0.8 0.625 I 1 0.2 5 J 1 0.50.625 K 1 0.8 1.255.2.2 Compound A-7 Drug Product Compounding

Compound A-7 suspensions (265 mg/mL±10%) were prepared by adding 3 mL ofinjection vehicles listed in Table 1 to 1032 mg of Compound A-7 bulkrecrystallized drug substance in a 5 ml siliconized glass vial. Eachvial was sealed with a rubber stopper and an aluminum seal. Suspensionsvials were roughly mixed by vortexing and tapping to facilitate initialwetting of the solids. Each vial was then sonicated in a bath sonicatorfor 10 minutes, with ˜5 second vortexing every minute.

5.2.4 Suspension particle size measurement

Particle size distribution of formulated suspension was measured on aHoriba LA910 laser diffraction particle size analyzer equipped with aflow through sample cell using 0.1% polysorbate 20 solution asmeasurement media. Suspension samples were prepared for measurement byre-suspending the vial containing drug product and then adding 0.1 mL ofsuspension to 10 mL of 0.1% polysorbate 20 solution. A sample was thenadded dropwise to the Horiba flow-through sample cell until dispersiontransmittance drops below 95%. The particle size metrics examined werevolume diameter where 10%, 50%, and 90% of the particle sizedistribution was smaller than that diameter (Dv[10]. Dv[50], andDv[90]).

5.2.5 Sediment Height Measurements

Sediment height was measured after allowing vials sit undisturbed for atleast 24 hours. A close up picture of all vials together was taken usinga digital camera, with lighting such that the sediment layer couldclearly be seen in the picture. The distance from the bottom of the vialto the surface of liquid layer and to the surface of sediment layer wasmeasured from each picture. The ratio of line lengths from each vialwere calculated and reported as sediment height in percentage, as shownin FIG. 3. A sediment height of 100% would indicate that no sedimentlayer is visible.

Injectability

Injectability was conducted to assess the ability of the suspension tobe passed through a 20 G or greater needle without clogging, withminimal resistance applied through use of a mesh screen.

5.2.7 Re-suspension Time

Re-suspension time was measured using a Burrel wrist action shaker.Vials were shaken at max amplitude on the wrist action shaker in aninverted orientation (cap down) for 5 second intervals. Re-suspensiontime was recorded when no visual clumps or caked material was observedat the bottom of the vial.

5.2.8 Microscopy

For microscopic analysis, 5 μL of suspension was placed on a glass slideand then diluted with 20 μL of same vehicle used to make the suspension.The sample was covered with a coverslip and examined at 10×magnification using an Olympus BX60 microscope. Pictures were takenusing an AxioCam MRc camera.

5.3 Design of Experiment

Using JMP 9 software, a central composite design of experiment (DOE) wasinitiated with the factors of SML (0-1% w/v) and polysorbate 20(0.1-0.8% w/v) concentrations. Previous experiments showed that at least0.1% polysorbate 20 is required to adequately wet a 25.6 wt % solidsload of Compound A-7 bulk recrystallized drug substance therefore thelower limit of 0.1% is deemed to be the lowest possible level of thesurfactant required to achieve wetting of the highly hydrophobicCompound A-7 crystals. The final DOE factors are summarized in Table 3.

TABLE 3 Design of Experiment Factors to look at varied concentrations ofSML and polysorbate 20 SML/Polysorbate 20 Sample SML % Polysorbate 20%Ratio 1 0 0.8 0 2 0 0.5 0 3 1 0.8 1.25 4 0 0.2 0 5 0.5 0.5 1 6 0.5 0.5 17 0.5 0.2 2.5 8 0.5 0.5 1 9 1 0.5 2 10 0.5 0.8 0.625 11 1 0.2 5 12 0.50.1 5 13 0 0.1 0

The measured responses were: sediment height, re-suspension time,particle size distribution (Dv[10], Dv[50], and Dv[90]), andinjectability. Microscopy was also performed on each sample.

6.0 Results and Discussion

6.1 Microscopy and Visual Observations

Microscopy of three suspensions made with vehicle containing 0.2%polysorbate 20 and increasing amounts of SML are shown in FIG. 4. It isvisually clear that flocculation is occurring as SML content in thevehicle increases. Measured suspension PSD, listed below each image inunits of microns, increases relative to the PSD method variability(approx. 2-3 microns) with increased degree of flocculation. Thisobservation supports using suspension particle size measurements toquantify flocculation in that the method preparation maintainsflocculation induced by the vehicle. The methodologies established bythis type of pilot experiment facilitated the initiation of DOEexperimentation.

6.2 DOE Responses

The desired Compound A-7 drug product formulation attributes includemaximum ease of resuspension and injectability, the ability of thesuspension to be passed through a 20 or greater gauge needle withoutclogging with minimal resistance applied through use of a mesh screen.Re-suspension time, sediment height, and suspension particle sizedistribution are all physical measurements of the formulated suspensionused to assess ease of re-suspension. These responses are related sinceparticle size of the suspension can be a measure of flocculation, whichincreases the sediment height and decreases re-suspension time. Asummary of all responses measured is listed in Table 4.

TABLE 4 Injectable (20-25 SML Polysorbate Sediment gauge Dv[10] Dv[50]Dv[90] Resuspension % 20% Height needle) (μm) (μm) (μm) Time (s) 1 0 0.839% Yes 8.7 25.2 53.8 15 2 0 0.5 34% Yes 8.6 24.5 51.2 20 3 1 0.8 68%Yes 10.9 28.3 57 10 4 0 0.2 34% Yes 8.5 24 51.3 20 5 0.5 0.5 50% Yes10.3 29.4 62.1 10 6 0.5 0.5 48% Yes 11 31.9 65.9 5 7 0.5 0.2 80% Yes14.4 33.6 61.6 5 8 0.5 0.5 48% Yes 10.4 30.4 62.7 10 9 1 0.5 73% No 15.936.3 66.2 5 10 0.5 0.8 34% Yes 8.7 24.8 55.8 20 11 1 0.2 84% No 20.1 4170.8 5 12 0.5 0.1 88% No 8.7 24 51.8 5 13 0 0.1 38% Yes 14.5 34.7 66.7206.3 Resuspension Time, Sediment Height and Particle Size Responses

A photograph of vials containing suspension after sedimentation withsediment height calculations is shown in FIG. 5. In the two panels ofFIG. 6 are plotted the observed re-suspension time vs. Dv[10] and Dv[50]values for each suspension. The measured re-suspension time and particlesize metrics exhibit an inverse relationship for the suspensions withsmaller measured particle size (below 11 and 32 microns for Dv[10] andDv[50], respectively). Larger measured suspension particle sizes, likelycaused by flocculation, facilitate faster re-suspension than smallerones.

Trends of particle size (Dv[10] and Dv[50]) with vehicle compositionwere modeled resulting in surface plots (not shown). As SMLconcentration increased and polysorbate 20 concentration decreased,suspension particle size reflected by Dv[10] and Dv[50] increased. Thesmallest Dv[10] and Dv[50] were measured from suspensions containingpolysorbate 20 with no addition of SML. For suspensions containing 0.1%polysorbate 20, Dv[10] and Dv[50] increased rapidly with increasing SML.These data are consistent with the understanding that SML is requiredfor the flocculation of the drug product, which results in an increasein apparent suspension particle size and therefore a decrease inre-suspension time.

6.5 Formulation Space

The desired Compound A-7 drug product is comprised of an injectionvehicle which facilitates re-suspension with optimal ease withoutdecreasing injectability of the suspension to an unacceptable level.Increases in measured suspension particle size parameters directlycorrelate to ease of re-suspension but inversely correlate withinjectability. Hence, a formulation with high SML wt % and lowpolysorbate 20 wt % would have the shortest re-suspension time but wouldalso have the worst injectability. The optimal vehicle composition isone where a balance between ease of resuspension and injectability isachieved through a balance in the amounts and ratios of SML andpolysorbate 20. The profiles in FIG. 6 show that when the measuredsuspension Dv[10] is greater than 11 μm or the measured suspensionDv[50] is greater than 32 microns, optimal re-suspension time isachieved. The values of 11 and 32 microns for Dv[10] and Dv[50],respectively, were used to set limits within the modeled data in orderto define the acceptable formulation space.

Previous experiments showed that at least 0.1% polysorbate 20 isrequired to adequately wet a 25.6 wt % 256 mg/mL±10% concentration ofCompound A-7 bulk recrystallized drug substance. In order to account forsmall changes in Compound A-7 bulk recrystallized drug substance surfacearea as well as potential loss of polysorbate 20 on stability, at least0.2% polysorbate 20 is recommended for the vehicle composition. At thispolysorbate 20 concentration, 0.5% SML concentration minimizes excipientlevels while still maximizing re-suspendability with acceptableinjectability. This surfactant combination is indicated in FIG. 7 by theintersection of the horizontal and vertical lines.

7.0 Example II Conclusion

Formulation performance of Compound A-7 suspensions containing varyingamounts and ratios of SML and polysorbate 20 were evaluated and a robustregion for the drug product which meets all target product attributeswas established. Compound A-7 suspension drug product formulated in aninjection vehicle containing 0.5% SML and 0.2% polysorbate 20 is withinthe robust region of the formulation space, as derived from analysis ofthe DOE executed. This vehicle composition minimizes excipient levelswhile co-optimizing resuspendabilty and acceptable injectability.

EXAMPLE III Injection Site Reaction Modulation

Subcutaneous Injection Site Reaction Model Protocol and Data

The following experimental protocol and data relate to the effect ofvehicle on the ISRs caused by subcutaneous (SC) administration ofaripiprazole (ARP) free base to rats.

Description of Experimental Design:

Overview of experimental design: There were 7 groups (n=6) in this studyevaluating ISRs caused by ARP formulated in 7 different vehicles; astandard vehicle was used as the control to which other compositions ofvehicle were compared. All groups received a single SC injection of ARPat a dose of 30 mg in a 1 mL dose volume. A 21-gauge, 1 inch needleattached to a 1 cc syringe was used to administer the drug. Ten daysfollowing injection with ARP, animals were euthanized by CO₂asphyxiation, and the ISR was excised and weighed. Weights of the ISRswere plotted against dose administered.

Materials and Methods:

Aripiprazole (ARP) dose 30 mgs;

Control Vehicle: 0.1% Polysorbate 20 (Tween® 20)/, 3% CMC, 0.9% NaCl inwater

-   -   Vehicle A: 0.2% Polysorbate 20 (Tween® 20)/0.5% sorbitan laurate        (Span® 20) in PBS buffer (10 mM, pH ˜7)    -   Vehicle F: 0.2% Polysorbate 40 (Tween® 40)/0.5% sorbitan        monopalmitate (Span® 40) in PBS buffer (10 mM, pH ˜7)    -   RELPREVV® Vehicle: CMC, mannitol, polysorbate 80, sodium        hydroxide and/or hydrochloric acid for pH adjustment, and water        for injection    -   Number of study animals: 42; Age: at least 6-8 weeks; Body        weight range: 300-350 grams upon receipt from supplier.        Description of Experiment, Animal Allocation and Procedures:

Test Period Procedures: Animals were dosed with ARP on Day 0. On StudyDay 10, all animals were euthanized, and the injection site reactiontissue/material was retrieved surgically and weighed immediately.

FIGS. 8A and 8B demonstrate that formulations comprising sorbitanlaurate demonstrated a significant reduction in injection site reactioncompared to formulations with no sorbitan laurate. FIG. 8A shows resultsfrom experiments with aripiprazole (free base), and FIG. 8B showsresults from experiments with olanzapine pamoate.

EXAMPLE IV Solubility of Compound A-7 in Vehicles Containing VaryingAmounts of Sorbitan Monolaurate

Sample preparation:

-   -   a. Injection vehicles comprised of ca. 10 mM phosphate buffer,        0.2% polysorbate 20, saline and various amount of sorbitan        laurate (0%-0.75%) were prepared. The injection vehicles were        stirred for 4 hours before preparing suspension preparation.    -   b. Approximately 1.25±0.05 g of Compound A-7 were added to 15 mL        injection vehicles in a 20-mL glass scintillation vial with a        ⅞″× 5/16″ stirring bar. The suspension was vigorously stirred on        Chemglass CG-1990-T-50 hotplate at 25° C. which was controlled        using a thermal sensor.    -   c. At each time point, a total of 3 mL of -mixed suspension were        transferred into two 1.5-mL centrifuge tubes using a plastic        pipette. The tubes were centrifuged at 14,000 rpm for 4 minutes.        The supernatant of both tubes were combined and centrifuged        again at 14,000 rpm for 4 minutes. The HPLC sample was then        prepared with final (2nd) centrifuged supernatant by diluting        0.4 mL supernatant with 0.6 mL THF.    -   d. Concentration of dissolved Compound A-7 was determined using        HPLC.

The data illustrated in FIG. 9 highlight the trends in Compound A-7concentration in solution as a function of SML content in the injectionvehicle. Surprisingly, the addition of a second surfactant, SML,decreases solubility up to 0.5 wt % SML with solubility increasing againabove 0.5 wt. % (e.g. 0.75 wt %) (middle line).

EXAMPLE V Prodrug Synthesis Procedures

Synthesis of Aripiprazole Prodrugs

Compound A-1: Preparation of7-(4-(4-(2,3-dichlorophenyl)piperazin-1-yl)butoxy)-1-(hydroxymethyl)-3,4-dihydroquinolin-2(1H)-one

A mixture of Aripiprazole (20 g, 45 mmol), triethylamine (1 mL, 7.1mmol), formaldehyde (37% aqueous solution, 70 mL) and dimethylformamide(200 mL) was heated to 80° C. for 20 h. The reaction mixture was cooled,diluted with ethyl acetate (400 mL) and washed with water/brine (1:1,3×500 mL). The organic phase was dried over MgSO₄, filtered andevaporated to dryness under vacuum to give hemi-aminal A-1 as a whitesolid (18.6 g, containing 25% Aripiprazole, 65% yield based on A-1).

Compound 1:(7-(4-(4-(2,3-dichlorophenyl)piperazin-1-yl)butoxy)-2-oxo-3,4-dihydroquinolin-1(2H)-yl)methylacetate

A solution of Compound A-1 (50.63 g, 0.105 mol) in anhydroustetrahydrofuran (THF, 80 mL) was treated with acetic anhydride (15.3 mL,0.16 mol) and heated for 2.0 hours at 60° C. (oil-bath). To the abovesolution, triethylamine (2.0 mL, 0.014 mol) was added and stirred for 16hours at 60° C. The solvent was removed using a rotator evaporator. Tothe resulting crude mixture, ethyl acetate (150 mL) and heptane (50 mL)was added. The solution was washed with NaHCO₃ (5% aqueous solution, 250mL,). After separation of the two layers, pH of the aqueous layer wasadjusted to above 7. The aqueous layer was further extracted using theorganic mixture. The organic layer was separated and washed with 5%NaHCO₃ solution, followed by deionized water, and brine. The solutionwas dried using anhydrous MgSO₄, filtered and evaporated under vacuum.The resulting product was purified using silica gel columnchromatography using ethanol: ethyl acetate (5:95) as the eluent.Fractions containing the desired product were combined and d-tartaricacid (12.5 g dissolved in 60:5 ethanol: water) was added, resulting inthe precipitation of the desired product (48.78 g, 89% yield). ¹H NMR(CDCl3, 300 MHz) δ 1.73 (m, 2H), 1.84 (m, 2H), 2.12 (s, 3H), 2.50 (t,2H), 2.68 (m, 6H), 2.87 (dd, 2H), 3.08 (m, 4H), 3.98 (t, 2H), 5.91 (s,2H), 6.59 (m, 2H), 6.96 (dd, 1H), 7.08 (dd, 1H), 7.15 (m, 2H).

Compound A-7:(7-(4-(4-(2,3-dichlorophenyl)piperazin-1-yl)butoxy)-2-oxo-3,4-dihydroquinolin-1(2H)-yl)methyldodecanoate

Compound A-7 was prepared in an analogous fashion to Compound 1. Thedesired product was isolated as a crystalline solid (0.3 g, 21% yield).The molecular weight was confirmed by mass spectrometer analysis. FIG.2-6 shows the PXRD, IR, Raman, TGA spectrum of the desired product. ¹HNMR (CDCl3, 300 MHz) δ 0.87 (t, 3H), 1.24 (m, 16H), 1.62 (m, 2H), 1.83(m, 2H), 1.86 (m, 2H), 2.36 (t, 2H), 2.49 (t, 2H), 2.68 (m, 6H), 2.86(dd, 2H), 3.08 (m, 4H), 3.97 (t, 2H), 5.91 (s, 2H), 6.59 (m, 2H), 6.96(dd, 1H), 7.07 (dd, 1H), 7.14 (m, 2H).

Compound A-28:(7-(4-(4-(2,3-dichlorophenyl)piperazin-1-yl)butoxy)-2-oxo-3,4-dihydroquinolin-1(2H)-yl)methylbenzylcarbamate

To a solution of hemi-aminal A1 (4 g, 8.4 mmol), 4-dimethylaminopyridine(0.15 g, 1.3 mmol) and triethylamine (1.1 mL, 7.5 mmol) indichloromethane (30 mL) was added benzylisocyanate (1.03 mL, 8.3 mmol)and the reaction mixture stirred for 24 hours. The reaction mixture wasthen heated at 35° C. for 20 hours, cooled and washed with water/brine(1:1, 50 mL). The organic phase was dried over MgSO₄, filtered andevaporated under vacuum. The residue was further purified bychromatography on silica eluting with ethylacetate/dichloromethane/methanol (1:1:0.1) to give the desired productas an off white foam (530 mg, 14% yield). ¹H NMR (CDCl₃, 300 MHz) δ1.58-1.88 (m, 4H), 2.48 (t, 2H), 2.60-2.72 (m, 6H), 2.85 (m, 2H),300-3.12 (m, 4H), 3.96 (t, 2H), 4.40 (d, 2H), 5.13 (NH), 5.96 (s, 2H),6.58 (dd, 1H), 6.79 (d, 1H), 6.92-6.98 (m, 1H), 7.04 (d, 1H), 7.12-7.16(m, 1H), 7.23-7.35 (m, 6H); m/z (M⁺H) 611.12 and 613.10.

Compound A-4:(7-(4-(4-(2,3-dichlorophenyl)piperazin-1-yl)butoxy)-2-oxo-3,4-dihydroquinolin-1(2H)-yl)methylhexanoate

Compound A-4 was prepared in an analogous fashion to Compound A-28. Thedesired product was isolated as a yellow solid (3.69 g, 87% yield). ¹HNMR (CDCl₃, 300 MHz) δ 0.78 (t, 3H), 1.11-1.28 (m, 4H), 1.40-1.78 (m,6H), 2.20-2.40 (m, 4H), 2.40-2.60 (m, 6H), 2.73-2.81 (m, 2H), 2.85-3.00(m, 4H), 3.88-4.00 (m, 2H), 5.75-5.83 (m, 2H), 6.55-6.62 (m, 2H),7.03-7.12 (m, 2H), 7.20-7.26 (m, 2H). m/z (M⁺H) 576.4 and 578.4.

What is claimed is:
 1. A pharmaceutical composition comprising: (a)compound of Formula (III) or (IV):

 wherein R³ is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; R⁴is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; wherein each R¹is independently selected from the group consisting of hydrogen,substituted or unsubstituted aliphatic, and substituted or unsubstitutedaryl; and wherein Y^(⊖)is a pharmaceutically acceptable counterion; (b)sorbitan laurate; (c) polysorbate 20; and (d) an aqueous vehicle whereinthe composition forms an aqueous, flocculated, injectable suspension. 2.The composition of claim 1, wherein the composition comprises components(b) and (c) at a ratio that results in flocs comprising component (a),wherein the flocs settle to greater than a predetermined sediment bedheight, such that components (a), (b) and (c) can be resuspended forinjection.
 3. The composition of claim 2, wherein the bed height iscomprised of at least a 20 to 80% increase in sediment height comparedto a non flocculated composition after 24 hours of undisturbed sitting.4. The composition of claim 2, wherein components (a), (b) and (c) canbe resuspended for injection within 1-60 seconds of handshaking.
 5. Thecomposition of claim 1, wherein the ratio of components (b) to (c) issuch that the composition can be injected using a 20 to 25 gauge needle.6. The composition of claim 2, wherein (a), (b), and (c) form flocshaving the following sizes: Dv[10]: 2-10μm, Dv[50]: 10-30μm, and Dv[90]:less than 65μmM.
 7. The composition of claim 1, wherein the ratio ofcomponents (b) to (c) is approximately 5 to 2, by weight.
 8. Thecomposition of claim 1, comprising about 0.2-1 weight percent sorbitanlaurate.
 9. The composition of claim 1, comprising about 0.4-0.7 weightpercent sorbitan laurate.
 10. The composition of claim 1, comprisingabout 0.5 weight percent sorbitan laurate.
 11. The composition of claim1, comprising about 0.05-0.8 weight percent polysorbate
 20. 12. Thecomposition of claim 1, comprising about 0.1-0.3 weight percentpolysorbate
 20. 13. The composition of claim 1, comprising about 0.2weight percent polysorbate
 20. 14. The composition of claim 1,comprising approximately 15-35 weight percent compound of formula III orIV.
 15. The composition of claim 1, comprising approximately 20-30weight percent compound of formula III or IV.
 16. An injectablepharmaceutical composition comprising: (a) a compound of formula III orIV:

 wherein R³ is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; R⁴is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; wherein each R¹is independently selected from the group consisting of hydrogen,substituted or unsubstituted aliphatic, and substituted or unsubstitutedaryl; and wherein Y^(⊖)is a pharmaceutically acceptable counterion;wherein component (a) is in a weight ratio of approximately 15-35%; (b)sorbitan laurate in a weight ratio of approximately 0.2-1% (c)polysorbate 20 in a weight ratio of approximately 0.05-0.8%; and (d) anaqueous carrier.
 17. An injectable composition comprising: (a) acompound of formula III or IV:

 wherein R³ is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; R⁴is—CH₂OC(O)R¹, —CH₂OC(O)OR¹, —CH₂OC(O)N(R¹)₂ or —C(O)R¹; wherein each R¹is independently selected from the group consisting of hydrogen,substituted or unsubstituted aliphatic, and substituted or unsubstitutedaryl; and wherein Y^(⊖)is a pharmaceutically acceptable counterion; (b)sorbitan laurate; (c) polysorbate 20; and (d) an aqueous vehicle. 18.The composition of claim 17, wherein the composition is formulated formodulating tissue reaction associated with the delivery of awater-insoluble antipsychotic agent.
 19. A method for treating disordersof the central nervous system, comprising administering an effectiveamount of the composition of claim 1 to an individual in need of suchtreatment.
 20. The method of claim 19, wherein the disorder is selectedfrom the group consisting of anxiety, depression, bipolar disorder,autism-related irritability, and a psychotic condition.